tbuckley/cabot-search huggingface dataset:
P88 Higher socioeconomic status is associated with psoriasis
Authors: Or Dagan
Journal: British Journal of Dermatology (2023)

Abstract The role of several environmental risk factors such as stressful life events, smoking and overweight as triggers for psoriasis has been undoubtedly validated. Recent inquiries regarding the association between socioeconomic factors and psoriasis yielded contraindicating observations, and this relationship remains unclear. The aim was to measure the association between psoriasis and socioeconomic status (SES). We carried out a nationwide population-based cross-sectional study that included all patients insured by the Clalit healthcare organization (n = 4 604 994). Univariable and multivariable logistic regression analyses were conducted to explore the association between psoriasis and SES while controlling for potential medical and habitual confounders. The study population included 129 855 patients with psoriasis and 4 475 139 controls. The mean (SD) age of patients with psoriasis was 51.53 (19.96) years, and the proportion of females was 51.5%. Higher SES was associated with an increased prevalence of psoriasis. In a fully adjusted model, people within the highest socioeconomic level were 1.43-fold more likely to have psoriasis than those with the lowest SES [95% confidence interval (CI) 1.39–1.48; P &amp;lt; 0.001]; people of medium SES were 1.2-fold more likely to have psoriasis than those of the lowest SES [95% CI 1.18–1.26; P &amp;lt; 0.001 (P-value for linear trend &amp;lt; 0.001)]. There is a positive correlation between SES and psoriasis prevalence. Further investigation is warranted to elucidate which biologic or behavioural factors contribute to these findings.
DP24 A case of digital papillary adenocarcinoma linked to human papillomavirus-42
Authors: Amanpreet Kallu, Vidya Madhwapathi, Simon Tso, Richard Carr
Journal: British Journal of Dermatology (2023)

Abstract A 60-year-old man with known stage-4 non-small cell lung cancer (NSCLC) and previous right-thumb hidradenoma presented with a 5-month history of a growing vascular lesion on his right great toe. Histology revealed a digital papillary adenocarcinoma (DPA) and positive quantitative polymerase chain reaction (qPCR) for human papilloma virus (HPV)-42 (courtesy of Thomas Wiesner’s research team in Austria). Review of previous histology for the lung and thumb lesions showed histological features consistent with DPA. He re-presented after 2 years with metastatic DPA in his right posterior calf. Following wide local excision (WLE), this locally reoccurred, requiring further excision. Aside from chemotherapy for NSCLC, he was not immunosuppressed and had no history of HPV-related disease. Digital papillary adenocarcinoma is a rare and aggressive neoplasm of sweat glands. Despite being a low-grade tumour, the rates of metastases and reoccurrence are high. Distant metastases are common and can present years after initial presentation. Distant metastases without lymph node spread have been reported. The annual incidence in the USA is ~0.08 cases per 1 000 000, typically presenting in men aged 50–70 years as a solitary lesion on the digits. It can invade muscle, tendons and bone. Owing to its rarity, misdiagnosis and treatment delay are common (Kobayashi T, Hiura A, Oishi K et al. Aggressive digital papillary adenocarcinoma with multiple organ metastases: a case report and review of the literature. Am J Dermatopathol 2016; 38:910–14). Studies show a link between HPV-42 and DPA, with qPCR detecting HPV-42 in known DPA cases (HPV-42 negative in hidradenoma). Human papilloma virus-42 was previously unknown to be oncogenic, and HPV vaccines do not target HPV-42 (Leiendecker L, Neumann T, Jung PS et al. Human papillomavirus 42 drives digital papillary adenocarcinoma and elicits a germ cell-like program conserved in HPV-positive cancers. Cancer Discov 2022; 13:70–84). There are no clear management guidelines and no drug therapy for DPA. Case studies have shown chemotherapy to be ineffective. Management is surgical with either amputation or WLE to avoid reoccurrence or metastases (Leiendecker et al.). Clinical suspicion for DPA should be high given its aggressive nature with regular long-term follow-up to detect reoccurrence or metastases early. More research is required on the epidemiology of this rare tumour in the UK and Europe and on treatment strategy beyond surgical resection, targeting the link between HPV-42 and DPA.
Daytime-restricted feeding enhances running endurance without prior exercise in mice
Authors: Haoran Xin, Rongfeng Huang, Meiyu Zhou, Jianghui Chen, Jianxin Zhang, Tingting Zhou, Shushen Ji, Xiao Liu, He Tian, Sin Man Lam, Xinyu Bao, Lihua Li, Shifei Tong, Fang Deng, Guanghou Shui, Zhihui Zhang, Catherine C. L. Wong, Min-Dian Li
Journal: Nature Metabolism (2023)
DS12 Experience of electrochemotherapy in cutaneous tumours and skin metastases within a UK specialist tertiary centre
Authors: Brogan Kelly Salence, Meghna Shetty, Alastair Mackenzie-Ross, Emma Craythorne
Journal: British Journal of Dermatology (2023)

Abstract Electrochemotherapy (ECT) has gained recognition as an effective treatment that uses electrical pulses to permeabilize cell membranes in tumours, enhancing the cytotoxicity of anticancer agents. The National Institute for Health and Care Excellence suggests use of ECT for the management of primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in selected patients after discussion within a specialist skin cancer multidisciplinary team. It also supports ECT as a palliative treatment for metastases in the skin from tumours of nonskin origin and malignant melanoma (MM). The objective of the study was to evaluate the outcomes and complications of ECT with bleomycin when used for palliative and curative intent. A retrospective cohort study of all patients who underwent ECT in a UK tertiary centre was performed between June 2016 and December 2022. Seventy-one patients (28 men and 43 women) with a total of 89 tumours were included in the study (mean age 69 years; range 29–99). Prior treatments included surgery (n = 9; 13%), immunotherapy (n = 14; 20%), radiotherapy (n = 26; 37%) and chemotherapy (n = 18; 25%). The linear array electrode was used in most cases with median sequence of 47 (range 1–500). Electrochemotherapy was used for palliative intent in 73% (n = 52) and for curative intent in 27% (n = 19). For palliation, ECT was used to treat patients with MM (n = 18/52; 35%), SCC (n = 17/52; 33%) and breast cancer metastases (n = 11/52; 21%), often in patients who had progressed despite conventional management. The most common site treated was the lower limb (n = 16/52; 31%). Twenty-two patients in this group had a good or partial response, with reduction in tumour size, and 52% had improvement in their symptoms (n = 27/52). The crude 1-year survival in this group was 83% (n = 43/52). Complications of ECT when used for palliation included pain, ulceration, tonic–clonic seizure and pneumothorax. In those where ECT was used for curative intent, the majority had ECT for BCCs (n = 12/19; 63%). The most common site treated was the head and neck. Resolution was reported in 58% (n = 11/19) and partial response in 11% (n = 2/19), while two patients underwent excision following recurrence. Complications when used for curative intent included ectropion, indented scarring, nerve palsy, ulceration, pain and webbing. In our opinion, ECT may represent a robust and efficacious treatment option particularly for smaller, lower-risk tumours which may produce improved outcomes. Electrochemotherapy may serve as an alternative to surgical intervention, particularly in patients with multiple comorbidities, and can be used for primary tumour management.
P31 Trial design to improve inclusion of patients from ethnic minority backgrounds
Authors: Liam Bishop, Isabelle Smith, Rachael Gilberts, Jane Nixon, Miriam Wittmann
Journal: British Journal of Dermatology (2023)

Abstract The ALPHA trial was a UK National Institute for Health and Care Research-funded, multicentre, prospective, adaptive, two-arm parallel group randomized controlled trial. Consenting participants with severe chronic hand eczema (CHE) were randomized on a 1 : 1 basis to receive either alitretinoin or immersion psoralen + ultraviolet A in conjunction with concomitant topical corticosteroids, emollients and patient education. Different skin types might respond differently to phototherapy due to different pigmentation, so it was important to recruit an ethnically diverse patient group. This was reflected in the design and analysis of the trial. ALPHA included a substudy where photographs were taken in a subgroup of randomly selected consenting participants and used as a disease-assessment quality-assurance check. Following a discussion with the Trial Steering Committee patient representative, a protocol amendment was implemented so that all consenting participants of an ethnic minority background would be selected for the substudy to assess any differences by skin type. The minimization algorithm was amended to incorporate the skin type as a minimization factor to ensure balance between the treatment groups in terms of skin colour and incorporated as a covariate in the primary analysis. ALPHA recruited 441 participants between October 2015 and June 2021, of which 49 (11.1%) were participants from ethnic minority background (13% was the national average in 2011, and 18% was the national average in 2021). In total, 95.2% (n = 373/392) of White participants and 92% (n = 45/49) of participants from ethnic minority backgrounds provided consent to have photographs taken as part of ALPHA. A total of 113 (30.3%) consenting White participants were selected for the photographic substudy, and 36 (80%) ethnic minority participants were selected. The presentation will report on the agreement between assessors in terms of photographs by skin type. Details of disagreement between photographs will be explored through the use of other disease-assessment measures that provide extra detail on the clinical symptoms that may not be visible on a photograph. Through increased awareness of the importance of different skin types, the trial was adapted to ensure ALPHA recruited a proportion of participants from ethnic minorities similar to the proportion of people from ethnic minority backgrounds in the UK. As a result, the trial was an example of adapting trial design to acknowledge the differences across ethnic groups, and to lead to improved research outcomes for patients from ethnic minority backgrounds. We will conclude the presentation with some practical recommendations for equality, diversity and inclusion in dermatological clinical trials.
P49 Epidemiology of skin cancer by ethnicity in England, 2013–2020: a cohort study
Authors: Anna Ascott, Birgitta van Bodegraven, Shehnaz Ahmed, Catherine Harwood, Charlotte Proby, Mary Sommerlad, Sally Vernon, Claire Welsh, Zoe Venables
Journal: British Journal of Dermatology (2023)

Abstract Skin cancer rates are increasing worldwide and predominantly affect people of white ethnicity. Although less common, skin cancers in people with skin of colour (SOC) are more likely to experience diagnostic delays and higher mortality. High-quality epidemiological data on skin cancers in SOC are limited. SOC and skin phototype are not recorded in registry data; however, the ethnic group can be used as a somewhat limited proxy. The aim of this retrospective national cancer registry cohort study was to describe skin cancer epidemiology by the ethnic group. We identified a cohort of patients diagnosed with skin cancer in England (2013–2020) from the National Disease Registration Service (NDRS). The ethnic group is routinely recorded as self-reported during hospital visits in Patient Administration System and Hospital Episode Statistics datasets collected by the NDRS. We analysed data by the broad ethnic group [White, Asian (excluding Chinese), Black, Chinese, mixed, other, unknown]. We report counts, incidence, stage at presentation (melanoma only), referral pathway, anatomical location and geographical variation. The first basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) per patient were reported. More cases of skin cancers were diagnosed in Asian ethnicities than in Black and Chinese ethnicities, except for melanoma, which was more frequently diagnosed in Black ethnicities. Of 713 615 BCCs, 571 396 (80.1%) were reported in White, 799 (0.1%) in Asian, 634 (0.1%) in mixed, 413 (0.1%) in Black, 156 (0.02%) in Chinese and 3122 (0.4%) in people of ‘other’ ethnicities; 137 095 (19.2%) were of ‘unknown’ ethnicity. Of 244 072 cSCCs, 225 534 (92.4%) were in White, 609 (0.2%) in Asian, 354 (0.1%) in Black, 279 (0.1%) in mixed, 66 (0.03%) in Chinese and 1137 (0.5%) in people of ‘other’ ethnicity; 16 093 (6.6%) were of ‘unknown’ ethnicity. Of 111 676 melanomas, 102 273 (91.6%) were in White, 199 (0.2%) in Black, 180 (0.2%) in Asian, 125 (0.1%) in mixed, 25 (0.02%) in Chinese and 695 (0.6%) in ‘other’ ethnicities; 8179 (7.3%) were of ‘unknown’ ethnicity. This is the first national study of skin cancer types by ethnicity in England. National datasets allow for the better evaluation of rare subgroups of patients. The main limitation is the high proportion of unknown ethnicity reporting, which is higher for keratinocyte cancers than for other cancers, presumably due to their automated processing and lack of data sources (i.e. inpatient or multidisciplinary team datasets). These data will support a better understanding of unmet clinical needs in underserved populations.
PA15 Becker naevus syndrome associated with a mosaic pathogenic variant in <i>ACTB</i>
Authors: Radhika Bali, Khawar Hussain, Nerys Roberts, Bisola Laguda
Journal: British Journal of Dermatology (2023)

Abstract A 15-year-old girl presented with an 8-year history of a gradually enlarging, irregular, nonconfluent hyperpigmented patch on her left flank. The lesion demonstrated an area of increased hair growth, did not cross the midline and was mildly pruritic but otherwise asymptomatic. Another pigmented patch, present since birth, was also noted on her right lower back and was consistent with a café-au-lait macule. Medical history included a marfanoid phenotype with musculoskeletal complications including scoliosis and joint hypermobility, for which she was under the care of the orthopaedic team for bilateral patellar instability associated with recurrent dislocation. She was also noted to have increased skin laxity, mild pectus excavatum, mitral valve prolapse and symptomatic tachyarrhythmias. She was born at term, to nonconsanguineous parents, with no postnatal developmental concerns. There was a family history of an older brother with significant scoliosis and hip dysplasia requiring hip replacements, developing from the age of 14 years. Genetic testing was negative for FBN1 and five other genes associated with Marfan syndrome. Thyroid function and bone profile were normal. Menarche occurred at 11 years of age, and a full hormone profile was normal except for a mildly raised prolactin level, deemed to be a normal variant in puberty. Abdominal and pelvic ultrasounds were normal. Skin biopsy from the left flank revealed orthokeratosis, irregular elongation of rete ridges and sparse perivascular chronic inflammation in the superficial dermis. Next-generation sequencing and droplet digital polymerase chain reaction from DNA extracted from skin revealed de novo mosaic pathogenic variants in ACTB, which encodes β-actin, an intracellular protein involved in cell migration, signalling and proliferation. Recurrent mosaic variants in ACTB have previously been associated with 61% of Becker naevi and one case of Becker naevus syndrome in one study (Cai ED, Sun BK, Chian A et al. Postzygotic mutations in beta-actin are associated with Becker’s nevus and Becker’s Nevus syndrome. J Invest Dermatol 2017; 137:1795–8), as well as congenital smooth muscle hamartomas and odontomaxillary dysplasia. Our patient had cutaneous and extracutaneous features suggestive of Becker naevus syndrome. This rare syndrome predominantly involves skeletal and soft tissue abnormalities, with breast hypoplasia most frequently reported. Notable features here include a café-au-lait macule, scoliosis and pectus excavatum. This case highlights the value of DNA analysis from skin in confirming a diagnosis, after 9 years of presentation to paediatric services. Given the heterogeneous extracutaneous phenotypes, there are also important implications for counselling and screening of associated conditions.
P09 A case of suspected COVID-19 vaccine-induced antiphospholipid syndrome
Authors: Patrick Bryan, Namor Williams, Geraldine Haebich
Journal: British Journal of Dermatology (2023)

Abstract A 50-year-old man presented with an acute onset, painful leg ulcer affecting his right calf. This developed 2 weeks after his second COVID-19 vaccine. It started with a painful erythematous plaque, which evolved slowly into a deep-seated 5-cm ulcer over a 6-week period. A thorough review was unremarkable. He had no significant medical history and was a keen athlete and nonsmoker. His father had an unspecified stroke in his 80s. Examination revealed no signs of chronic venous insufficiency or discoloration to his foot, and his neurovascular examination was unremarkable. Investigations for antineutrophil cytoplasm antibodies, antinuclear antibody, complement, paraprotein, HIV and hepatitis were all unremarkable. Biopsy demonstrated nonspecific inflammatory changes, and wound swabs were unremarkable. Initial treatment with oral antibiotics, regular dressings, compression, topical emollients, Dermovate® and prednisolone (0.5 mg kg−1) was only partially effective. He subsequently developed additional painful superficial erosions and ulcers affecting the same limb involving the calf and shin, with a surrounding erythematous livedoid-like rash involving his shin. Rebiopsy demonstrated superficial and deep dermal and subcutaneous thrombosis without vasculitis. Direct immunofluorescence showed the presence of fibrinogen within dermal vessels. Further investigations demonstrated the presence of lupus anticoagulant. Factor V Leiden, protein C and S, anti-B2-GP1 and anticardiolipin antibodies, antithrombin III, homocysteine and coagulation profile were all unremarkable. Histological confirmation of thrombosis and the presence of serum lupus anticoagulant confirmed the diagnosis of antiphospholipid syndrome (APS). He was started on warfarin and the ulcers improved. APS is a rare autoimmune disorder characterized by recurrent miscarriage, thrombophilia and the presence of antiphospholipid autoantibodies (either serum lupus anticoagulant, anti-B2-GP1 or anticardiolipin autoantibodies). Positivity for APS antibodies can be found in up to 5% of the general population. An individual must have the clinical features and antibody positivity to be diagnosed with APS. The temporal relationship with his second COVID-19 vaccine raises the possibility of vaccine-induced APS. COVID-19 vaccine-induced APS is limited to just a few case reports (Moreno-Torres V, Gutiérrez A, Valdenbro M et al. Catastrophic antiphospholipid syndrome triggered by mRNA COVID-19 vaccine. Clin Exp Rheumatol 2022; 40:1054–5). It is postulated that mRNA vaccines may induce a rare complex immunogenic response characterized by a type 1 interferon reaction. This results in a prothrombotic cascade in individuals with pre-existing APS autoantibody positivity (Talotta R, Robertson E. Antiphospholipid antibodies and risk of post-COVID 19 vaccination thrombophilia: the straw that breaks the camel’s back? Cytokine Growth Factor Rev 2021; 60:52–60).
008 How often and how quickly do people with a first cutaneous squamous cell carcinoma develop further tumours? Analysis of national registry data between 2013 and 2020 in England
Authors: Birgitta van Bodegraven, Sally Vernon, Cong Chen, Catherine A Harwood, Rubeta N Matin, Charlotte Proby, Zoe C Venables
Journal: British Journal of Dermatology (2023)

Abstract In England, cutaneous squamous cell carcinoma (cSCC) has an incidence rate of 85.2 per 100 000 person-years and over 30 000 new incident patients annually. Subsequent cSCC are common. Improved understanding of the frequency and time frames is important for cancer prevention, management guidelines and service provision. The aim of this study was to describe national cSCC accrual data in England. This retrospective cancer registry cohort study used data provided by the National Disease Registration Service. Cancer registrations are created from National Health Service (NHS) data feeds, primarily pathology reports from NHS laboratories. Patients with a first-ever registered cSCC during 2013–2015 were identified. All cSCC pathology reports from 2013 to 2020 were analysed in the 5 years following the first cSCC diagnosis date. To account for supplemental reporting and the possibility that two reports within a short time frame double count the same tumour (e.g. diagnostic biopsy followed by therapeutic excision), a washout period of 112 days (16 weeks) was used (i.e. cSCC was designated as a separate tumour when registration exceeded this period after the preceding cSCC diagnosis date). Sensitivity analysis assessed effects of several washout periods. Pathology reports were not reviewed, and a proportion of subsequent tumours may represent recurrences beyond the washout period or delayed treatment. A total of 79 301 first-ever cSCC tumours were registered. After applying the 112-day washout period, 22 225 subsequent tumours remained for analysis up to 2020. In total, 15 544 (19.6%), 4437 (5.6%) and 1426 (1.8%) of people developed a second, third and fourth cSCC tumour within 5 years, respectively. Within 1 year of the first-ever cSCC, 5676 (7.2%) patients had a second cSCC, increasing to 15.1% (n = 11 968) and 19.6% (n = 15 544) by years 3 and 5, respectively. The median interval between first and second cSCC was 550 days [interquartile range (IQR) 256–1046], second-to-third cSCC interval 392 days (IQR 219–708), third-to-fourth 283 days (IQR 175–492) and fourth-to-fifth 235 days (IQR 160–398). The accrual estimates are sensitive to the washout period. However, even with a 365-day washout period, 3.4% and 5.1% had developed a second cSCC by years 3 and 5, respectively. These data show that one in five patients will develop another cSCC within 5 years of their first-ever cSCC. Data on cSCC accrual rates are limited globally to single-centre or regional datasets. This national study provides detailed information on accrual rates in England, which are important for informing all aspects of clinical care, health service provision and design of future clinical trials for cSCC prevention.